1710082508 NPI number — CANDACE D KOIRTH ARNP

Table of content: CANDACE D KOIRTH ARNP (NPI 1710082508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710082508 NPI number — CANDACE D KOIRTH ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOIRTH
Provider First Name:
CANDACE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710082508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 COMMODORE ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PRATT
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67124-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-900-7762
Provider Business Mailing Address Fax Number:
620-450-1371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 COMMODORE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-900-7762
Provider Business Practice Location Address Fax Number:
620-450-1371
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  45129 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1286700009 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12867010010 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700002 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700007 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700008 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700011 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100416640A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1286700015 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500023194 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1286700004 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700005 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700003 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700012 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700006 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1286700013 . This is a "DMERC REGION 1" identifier . This identifiers is of the category "OTHER".




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